Chronic kidney disease is associated with increased 30-day mortality and morbidities after esophagectomy: a propensity score matched study

Background

Chronic kidney disease (CKD) is one of the most prevalent comorbid conditions in the US. While prior studies have established a correlation between CKD and increased mortality and complications in surgery, its impact on esophagectomy outcomes remains underexplored. This study aimed to assess the effect of CKD on the 30-day outcomes of esophagectomy using data from a national registry.

Methods

The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) esophagectomy-targeted database was used in this retrospective study. The period considered was from 2016 to 2022. Patients with CKD were selected based on an estimated glomerular filtration rate (eGFR) ≤ 60 mL/min/1.73m². A 1:2 propensity score matching was applied to CKD and non-CKD patients for demographics, baseline characteristics, neoadjuvant therapy, surgical approaches, tumor diagnosis, and staging of the malignancy. The 30-day postoperative outcomes were then compared.

Results

There were 655 (8.30%) and 7232 patients with and without CKD who underwent esophagectomy, respectively, whereby 1310 non-CKD patients were matched to all CKD patients. After propensity score matching, CKD patients had higher mortality (6.72% vs. 3.44%, p < 0.01), pulmonary complications (28.85% vs. 23.21%, p = 0.01), renal complications (7.18% vs. 2.44%, p < 0.01), sepsis (16.03% vs. 12.14%, p = 0.02), and bleeding requiring transfusion (16.64% vs. 12.06%, p = 0.01).

Conclusion

CKD can be an independent risk factor for adverse outcomes following esophagectomy. This underscores the importance of thorough preoperative risk stratification and the need for targeted management strategies for patients with CKD to potentially improve their surgical outcomes.